Provider First Line Business Practice Location Address:
2330 EASTGATE ST STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-1589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-828-4741
Provider Business Practice Location Address Fax Number:
509-508-4697
Provider Enumeration Date:
12/03/2025